On January 2, 1998, Mr. C, an obese, white caucasian male, who
appeared approximately 65 years old, but who could not accurately
state his age, presented to my family practice office with complaints
of generalized aches and pains, sore red eyes, depression, and
general malaise. The patient's face was erythematic, and he was in
mild respiratory distress, although his demeanor was jolly. He
attributed these symptoms to being "not as young as I used to be, HO!
HO! HO!", but thought he should have them checked out. The patient's
occupation is delivering presents once a year, on December 25th, to
many people worldwide. He flies in a sleigh pulled by eight
reindeer, and gains access to homes via chimneys. He has performed
this work for as long as he can remember. Upon examination and
ascertaining Mr. C's medical history, I have discovered what I
believe to be a unique and heretofore undescribed medical syndrome
related to this man's occupation and lifestyle, named Aerial
Sleigh-Borne Present-Deliverer's Syndrome, or ASBPDS for short.

Medical History: Mr. C. admits to drinking only once a year, and only
when someone puts rum in the eggnog left for him to consume during his
working hours. However, I believe his bulbous nose and erythematic
face may indicate long-term ethanol abuse. He has smoked pipe tobacco
for many years, although workplace regulations at the North Pole have
forced him to cut back to one or two pipes per day for the last 5
years. He has had no major illnesses or surgeries in the past. He
has no known allergies. Travel history is extensive, as he visits
nearly every location in the world annually. He has had all his
immunizations, including all available vaccines for tropical
diseases. He does little exercise and eats large meals with high
sugar and cholesterol levels, and a high percentage of calories
derived from fat (he subsists all year on food he collects on Dec.
25, which consists mainly of eggnog, Cola drinks, and cookies).
Family history was unavailable, as the patient could not name any
relatives.

Physical Examination and Review of Systems, With Social/Occupational Correlates:
The patient wears corrective lenses, and has 20/80
vision. His conjunctivae were hyperalgesic and erythematous, and
Fluorescein staining revealed numerous randomly occurring corneal
abrasions. This appears to be caused by dust, debris, and other
particles which strike his eyes at high velocity during his flights.
He has headaches nearly every day, usually starting half way through
the day, and worsened by stress.

He had extensive ecchymoses, abrasions, lacerations, and first-degree
burns on his head, arms, legs, and back, which I believe to be caused
mainly by trauma experienced during repeated chimney descents and
falls from his sleigh. Collisions with birds during his flight,
gunshot wounds (while flying over the Los Angles area) and bites
consistent with reindeer teeth may also have contributed to these
wounds. Patches of leukoderma and anesthesia on his nose, cheeks,
penis, and distal digits are consistent with frostbite caused by
periods of hypothermia during high-altitude flights. He had a blood
pressure of 150/95, a heart rate of 90 beats/minute, and a
respiratory rate of 40. He has had shortness of breath for several
years, which worsens during exertion. He has no evidence of acute
cardiac or pulmonary failure, but it was my opinion that he is quite
unfit due to his mainly sedentary lifestyle and poor eating habits
which, along with his stress, smoking, and male gender, place him at
high risk for coronary heart disease, myocardial infarction,
emphysema and other problems. Blood tests subsequently revealed
higher-than-normal CO levels, which I attribute to smoke inhalation
during chimney descent into non-extinguished fireplaces. He has
experienced chronic back pain for several years. A neurological
examination was consistent with a mild herniation of his L4-L5 or
L5-S1 disk, which probably resulted from carrying a heavy sack of
toys, enduring bumpy sleigh rides, and his jarring feet-first falls
to the bottom of chimneys. Mr. C. had a swollen left scrotum, which,
upon biopsy, was diagnosed as scrotal cancer, the likely etiology
being the soot from chimneys.

Psychiatric Examination and Social/Occupational Correlates: Mr. C's
depression has been chronic for several years. I do not believe it to
be organic in nature-rather, he has a number of unresolved issues in
his personal and professional life which cause him distress. He
exhibits long-term amnesia, and cannot recall any events more than 5
years ago. This may be due to a repressed psychological trauma he
experienced, head trauma, or, more likely, the mythical nature of his
existence. Although the patient has a jolly demeanor, he expresses
profound unhappiness. He reports anger at not receiving royalties for
the widespread commercial use of his likeness and name. Although he
reports satisfaction with the sex he has with his wife, I sense he may
feel erotic impulses when children sit on his lap, and I worry he may
have pedophillic tendencies. This could be the subconscious reason he
employs only vertically-challenged workers ("elfs"), but I believe his
hiring practices are more likely a reaction formation due to
body-image problems stemming from his obesity. The patient feels
annoyed and worried when he is told many people do not believe he
exists, and I feel this may develop into a serious identity crisis if
not dealt with. He reports great stress over having to choose which
gifts to give to children, and a feeling of guilt and inadequacy over
the decisions he makes as to which children are "naughty" and "nice".
Because he experiences total darkness lasting many months during
winter at the North Pole, Seasonal Affective Disorder (SAD) may be a
contributor to his depression.

Treatment and Counselling: All Mr. C's wounds were cleaned and
dressed, and he was prescribed an antibiotic ointment for his eyes. A
referral to a physiotherapist was made to ameliorate his disk problem.
On February 9, a bilateral orchidectomy was performed, and no further
cancer has been detected as of this writing. He was counselled to
wash soot from his body regularly, to avoid lit-fire chimney descents
where practicable, and to consider switching to a closed-sleigh,
heated, pressurized sleigh. He refused suggestions to add a helmet
and protective accessories to his uniform. He was put on a
high-fibre, low cholesterol diet, and advised to reduce his smoking
and drinking. He has shown success with these lifestyle changes so
far, although it remains to be seen whether he will be able to resist
the treats left out for him next Christmas. He visits a psychiatrist
weekly, and reports doing "Not too bad, HO! HO! HO!".

Conclusions: Physicians, when presented with aerial sleigh-borne
present-deliverers exhibiting more than a few of these symptoms,
should seriously consider ASBPDS as their differential diagnosis. I
encourage other physicians with access to patients working in allied
professions (e.g.Nightly Teeth-Purchasers or Annual Candied Egg
Providers) to investigate whether analogous anatomical/ physiological/
psychological syndromes exist. The happiness of children everywhere
depend on effective management of these syndromes.